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KMID : 0869620190360030315
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Journal of Korean Society of Hospital Pharmacists
2019 Volume.36 No. 3 p.315 ~ p.324
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Evaluation of Risk Factors for Acute Renal Injury in Critically Ill Patients
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Ahn Seo-Hyun
Ahn Hye-Lim
Hwangbo Shin-Yi
Choi Sun
La Hyen-O
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Abstract
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Background : Acute kidney injury (AKI) is an abrupt loss of kidney function. Specifically, AKI occurring in intensive care units (ICU) is associated with increased mortality, morbidity, and length of hospital stay. Therefore, prevention and early treatment of AKI is important. This study analyzed the risk factors and prognosis of AKI in the ICU and evaluated correlations between the use of nephrotoxic drugs and the occurrence of AKI.
Methods : In this retrospective study, patients who were treated more than 48 hours in the medical intensive care unit from March 2015 to June 2015, were included. Those who had received dialysis and had chronic kidney disease (CKD) stage 5 upon admission were excluded. AKI was defined as an increase in serum creatinine more than 150% from baseline, according to RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease) criteria. The patients were divided into two groups, the AKI group and the non-AKI group. Risk factors were analyzed by comparing such factors as underlying diseases and the use of nephrotoxic drugs in both groups.
Results : A total of 148 patients met the inclusion criteria and were included in the analysis. AKI occurred in 69 patients (46.6%). The frequencies of sepsis, chronic obstructive pulmonary disease (COPD), and adult respiratory distress syndrome (ARDS), and the use of amphotericin B, colistin, vasopressors, and diuretics were significantly greater in the AKI group than in the non-AKI group (p < 0.05). The number of concomitant nephrotoxic drugs used by patients in the AKI group was greater than in the non-AKI group. Significant effects of sepsis and colistin were confirmed with multiple regression analysis (p=0.020, p=0.005). Twenty-six patients in the AKI group recovered and the average recovery period was 8.8 days.
Conclusions : AKI is a relatively common disease in ICU patients. Sepsis and use of colistin were shown to be important risk factors of AKI. Based on the results of this study, we suggest that active intervention by pharmacists is important for patients with these risk factors.
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KEYWORD
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ICU, AKI, Risk factor, Sepsis, COPD
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